Home Exercise Vs. Supervised Exercise For Lower Back Pain

Summary
It has been observed that there are several therapies that are beneficial in the management of chronic lower back pain. Some of these therapies include exercise and certain manipulations of the spine. However, it is not known if exercising at home is comparable in efficacy with supervised spinal exercises. This study attempted to compare the two types of exercises. The study sample was divided into three groups; two groups with short- and long-term supervised exercises respectively, and one group with home exercises. Results showed that all three groups benefited from the exercises. The minor differences between the groups in terms of patient-rated pain, disability, improvement, general health status, and medication use were not significantly higher in the supervised group.

Introduction
Lower back pain affects up to 80 percent of individuals sometime in their lifetime and nearly 75 percent of such people continue to experience it for over one year after its onset. The United States spends an approximate $100 billion per year in the management of lower back pain. However, there are no standard therapy guidelines for the control of symptoms of chronic lower back pain. Some studies have shown that the symptoms are relieved and patients may benefit by regular supervised exercises. Another alternative is self-monitored home exercises. These are known to be effective in a sudden onset of lower back pain, but nothing is known regarding their effectiveness in chronic lower back pain. This study was conducted to analyze the effectiveness of short- and long-term supervised spinal exercises and compare it to the results of short-term home exercises.

Methodology
* The study included 301 patients between 18 and 65 years of age, who suffered from lower back pain for the last six weeks.
* The patients were divided into three groups; one group with short (12 weeks) and another group with long (52 weeks) of supervised exercises. The third group received a short course of exercises at home.
* All the patients were assessed for disability, pain, health status, use of pain drugs, improvement of symptoms and satisfaction with therapy. Strength of the trunk muscles was also assessed for the patients.

Data/Results/Key Findings
* Results revealed that all three groups benefited from the exercises.
* Those patients in the short- and long-term supervised exercise groups were satisfied with the therapy and at the end of the study showed maximum trunk muscle strength and endurance.
* However, this difference was not significantly greater than the home exercise group, especially in view of other factors such as outcomes, pain and disability, health status and use of pain relieving medications.

Next steps/Shortcomings
Authors admit that this study was not planned to check for other patient-specific factors that affect patient satisfaction. This includes factors such as specific attention to patient and provider interactions. Also, all the patients knew the group they belonged to and this could have affected their perception of satisfaction and improvement with the therapy. Authors suggest that further research should involve different approaches to alleviate chronic lower back pain in larger studies.

Conclusion
This study showed that in sufferers of chronic lower back pain, supervised exercise over a long-term provides more patient satisfaction and improves trunk muscle strength and endurance when compared to home exercises. However, although differences in terms of “patient-rated pain, disability, global improvement, general health status, and medication use consistently favored the supervised exercise group,” the difference itself between the therapy groups was not significant. Authors suggest that further studies are needed to understand the mechanism that causes this type of chronic lower back pain to devise specific and more cost-effective measures to treat it.

For More Information:
Supervised Exercise, Spinal Manipulation, and Home Exercise for Chronic Low Back Pain: A Randomized Clinical Trial
Publication Journal: The Spine Journal, 2011
By Gert Bronfort, DC, PhD; Michele Maiers, DC, MPH; Northwestern Health Sciences University, St, Bloomington, MN

*FYI Living Lab Reports Are Summaries of the Original Research.

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